1. Context
Philosophy generally refers to seeking answers to fundamental questions human beings have encountered throughout the history (1). These questions address the reality of the universe (ontology), whatever which can be recognized (epistemology), whatever is right and considered ethics and whether there is an art in healthcare (aesthetics). Philosophizing in the west is rooted in ancient Greece, and the word etymology emanates from the two parts of philosophy, i.e. philo meaning love and Sophia meaning wisdom (2). The concept of philosophy and philosophical research can be differently interpreted depending on the method used and the individual and the application involved. Philosophy can be used for values and beliefs about the universe and viewpoints on humans and their world or as a research method for answering specific questions, developing knowledge and studying the world and humans (3). Philosophy provides an infrastructure for decision making in all areas, and determines the orientation of activities. In other words, all actions and behaviors owe to the philosophical orientation. As an applied field, nursing is considered both a science and an art. The functions of modern nursing are mixed with complicated social situations. Philosophical attitudes are of great significance and related to the functions in this field. They constitute a basis for the nursing education and professional development, and help nurses with their roles (4, 5). Considering these dimensions and adopting a philosophical attitudes essential for defining and explaining the natural domain and the ultimate goal of professions such as nursing (6). Therefore, in the nursing profession, there is an ontological claim in expressing existing basic phenomena such as personal and health concepts, An explicit or implicit epistemological claim related to how to recognize the basic phenomena and its application to the development of knowledge, the aesthetic claim of the art of care in the nursing profession, and the ethical claim for statements about ethical values and beliefs and ethical concepts are used as a guide for how to practice in the clinical field (6). There is a general consensus that philosophy should guide the nursing practice; nevertheless, few studies have been conducted on the actual status of philosophy and philosophical nursing studies to help nurses understand what is occurring in the nursing world, and what should they do or follow in this respect (3, 7, 8). And nursing studies typically performed on clinical care or medical interventions (9-11). The present study was conducted to investigate the role of philosophy in nursing knowledge, education, insight and competence.
2. Evidence Acquisition
The present descriptive analytical study was conducted by searching international databases, including PubMed, Google Scholar, Science Direct, Ovid, Wiley, Web of Science, Magiran’s internal databases and SIDs, using keywords such as philosophy, philosophy and nursing education, philosophy in nursing, philosophical thinking, clinical thinking and philosophical attitude while disregarding time limits.
The studies included comprised systematic reviews, review studies, descriptive-cross sectional studies and qualitative studies on the role of nursing philosophy as well as those conducted on the role of philosophy in nursing knowledge or in nursing attitudes or in nursing competence. The excluded cases consisted of letters to the editor in chief, duplicate studies and philosophical studies on other professions.
A total of 32 studies meeting the inclusion criteria were selected from 126 studies obtained using the desired keywords. The descriptive information required was then extracted from these studies.
3. Results
The results obtained were classified into three groups of the role of philosophy in knowledge, insight and competence of nurses through a descriptive evaluation of the studies in terms of the study objectives.
3.1. The Role of Philosophy in Nursing Knowledge and Education
Nurses have been taught about proper thinking over the years. Appropriate thinking is valuable in both the nursing education and other professions (12). In modern university education systems, the ultimate goal is to produce people beyond the technicians who carry out routine tasks in their profession. Graduates of these systems must have creativity, imagination, communication skills, and ability to analyzing and combining situations. Targeted approaches in medical education are based on multidisciplinary integration and teaching individuals to respond to rapid changes in the community. In addition, professional members of the community are required to develop skills and acquire knowledge to fulfill their roles and tasks (13). Although many theorists have made efforts to propose rational methods for achieving these objectives, philosophy is historically the winner of this field and among the models and methods proposed to teach students, the prominent, innovative and philosophical model proposed by Matthew Lipman can be used to integrate philosophy with education (12). As an effective person in education, Lipman paved the way for developing a new paradigm, which has always been considered by education actors to be passed down. The Matthew Lipman’s model is appropriate for rapidly-developing communities moving towards globalization (14). The Lipman’s model is exactly based on the modern world of nurses and the changing nature of healthcare and globalization in nursing. According to Lipman, skilled thinkers have a critical, creative and compassionate way of thinking. Comparing critical to ordinary thinking, Lipman introduced ten components of critical thinking, namely estimating, evaluating, classifying, assuming, deducing, rationalizing, understanding the principles, paying attention to mutual relationships, suggesting by reason and judging by criteria. Creative and critical thinking based on this model is more associated with the cognitive domain of Bloom’s taxonomy, whereas caring thinking is more related to the emotional domain of this taxonomy. Caring thinking resembles a formula comprising critical thinking and creative thinking, and refers to the philosophical justification and confirmation of creative and critical thinking (12). Feelings can be turned into choices, decisions and even judgments through caring thinking. In fact, being philosophical means rationalizing in the same way as philosophers do (15). According to the Lipman’s model, philosophy provides a basis for professional knowledge and professional nursing care, and actually refers to the skills of critical thinking, creative thinking and caring thinking, confirming the ability of nurses to analyze, combine, rationalize, predict and think about the ideas, feelings and beliefs of others (16). Philosophical attitudes, especially in critical realism schools, help focus on changeable rather than unchangeable factors in the nursing education (17). Philosophical schools provide nursing educators with different educational methods to improve nursing education standards and evaluate, monitor, plan and measure the effectiveness of educational methods. It also facilitates the philosophy of evaluation programs in nursing education and especially in terms of evaluating and comparing the effectiveness of educational programs in nursing students with different demographic characteristics (18). Yousefzadeh et al. found that developing philosophical skills play as key role in promoting the level of learning and knowledge in the study departments, and that using an explorative teaching method can significantly affect the development of philosophical thinking skills (19). McCurry et al. found philosophy to provide nurses with the tools required for enhancing awareness in the nursing practice in a way that nurses can press the interactive frontiers of healthcare and evaluate nursing ethics and role in today’s world. Taking this attitude enables nurses to highlight important and potentially-unanswered professional issues, and promote the nursing knowledge in their profession (7, 20). Using interactive and non-interventional educational styles based on philosophical schools and supporting theories such as cognitive theory, constructivism, metacognition and self-efficacy theories play an effective role in the process of knowledge promotion, teaching, learning and self-assessment (21). In fact, the performance of an education system depends on the attitudes taken and the educational approach governing the system, and is affected by the philosophy dominating that area. Being aware of the point of emphasis in a theory can therefore develop critical thinking, which helps the designers of educational programs make an informed selection of positive points and avoid the negative aspects of the theory (22).
3.2. The Role of Philosophy in Nurses’ Insight
Philosophy is conceptually related to the main phenomena in nursing. The philosophical umbrella of contents affects nurses’ insight into the nature of nursing, personality, the environment, health and diseases in terms of cognition (3, 23, 24). The epistemology of nursing is considered the main factor in developing insight and identifying these concepts [nursing, personality, the environment, health and diseases] as the main paradigms of nursing (23, 25). Ethical insight in nursing refers to the ethical phenomena encountered in the nursing practice and fundamental elements, rights and values as well as the nature of good and professional nursing as the core of philosophical thinking (26, 27). Philosophy can be used as content for clinical nurses, nursing educators and nursing researchers, and for defining nursing goals and nurses’ attitudes to these goals in healthcare programs (7). Understanding the nature of appropriate nursing care and the relevant nursing knowledge can help nurses understand their roles in institutions and promote their insights into the nursing practice mechanism. Nurses can accordingly use care giving methods based on medical models and comprehensive and humanitarian care giving. Acquiring an appropriate understanding of nursing care and the philosophy for fulfilling these actions as nursing clinical skills by nurses therefore helps nursing practices be performed in a targeted and high-quality manner (28). Having a holistic attitude and considering human as an integral whole constitute the major insight into nursing care. According to McEvoy and Duffy, nursing is intrinsically holistic (29). The philosophy of comprehensive care giving is based on the notion that individuals are beyond a simple mind and body. In fact, human is composed of the body, the mind and the soul, making up an integral whole (29, 30). Perhaps, Nightingale was the first theoretician who believed in comprehensive care and defined the role of nurses as providing patients with the best conditions. Her nursing practice guideline has definitely helped comprehensive healthcare be approved for over a century (30). Having a holistic attitude and providing nursing services in this way are associated with philosophical thinking given that the thinking process helps nurses understand patient comprehensiveness. In fact, thinking in this way is effective enough in creating coordination and helping with the identification and elimination of irregularities (16).
3.3. The Role of Philosophy in Nurses’ Competence
The objectives of patient care are based on the acquisition of knowledge and skills. A qualitative study by Buller and Butterworth evaluated skillful nursing elements and found that the performance of skilled nurses to include work procedure, professionalism, appropriate communication and management as well as facilitating (31), suggesting that skilled nurses are thoughtful, as the basis for providing healthcare includes professional care, communicating with patients, their families and other members of the care team as well as having management and thinking skills (16). As an important thinking style among the different types and an integral part of social life, critical thinking simply refers to one’s ability to analyze and evaluate information (32). Developing critical thinking is therefore considered a fundamental educational objective at different levels (33). Critical thinking is a mental process and a philosophical issue in epistemology, which can be used for a better understanding of complicated ideas, and can help nurses analyze experiences and situations, and more effectively evaluate challenges of beliefs, values and hypotheses (34, 35). According to Watson and Glazer, critical thinking is a combination of knowledge, attitude and performance in each person, and involves skills such as deducing, identifying the hypotheses, inferring, analyzing and rationalizing (36). As the main path leading to comprehensive and holistic care, critical thinking lays the foundations for humanitarian care in addition to medical care (34). Experienced nurses should have critical thinking skills, which are required for skillful and humanitarian care. Creative thinking is one way to achieve competence in nursing, and according to Paull and Scriven (1978), is the process of analyzing, synthesizing and evaluating information. Given its direct effects on clinical complications in patients, creative thinking is considered a valuable concept in nursing practices and effective clinical decision-making, and in the field of nursing care, it refers to thinking when analyzing the status of patients, considering the position, demands and feelings of patients, using nursing practices and identifying the appropriate time for alternative therapies. Staib (2003) defined creative thinking in nurses, as their ability to rationalize, predict the consequences and transfer knowledge in clinical situations (37, 38). Nurses practically providing nursing care services, including the administration of medication and intubation or provision of other healthcare services, step by step and in an objective, precise, consistent and focused administration manner actually use creative thinking based on a kind of philosophical attitude. In fact, using creative and critical thinking in a philosophical manner to promote nursing practice is based on providing clinical guidelines and policies in a way that nurses can successfully provide nursing care services as per the existing standards (39).
4. Conclusions
Targeted approaches in medical education are based on multidisciplinary integration and training individuals to respond to rapid changes in the community. Moreover, professional members require skills and knowledge for fulfilling their roles and duties. Research suggests that integrating philosophical models with education is the only effective method for achieving this goal. These models promote critical, creative and compassionate thinking. In fact, caring thinking in nursing refers to the philosophical justification and confirmation of creative and critical thinking, and helps nurses with analyzing, combining, rationalizing, predicting and thinking about the ideas, feelings and beliefs of others, and provides a basis for professional knowledge and professional nursing care. The philosophical umbrella of concepts affects nurses’ insights into the nature of nursing, personality, the environment, health and diseases in terms of cognition, and the epistemology of nursing is considered the main factor in developing insight and identifying these concepts as the main paradigms of nursing. Furthermore, nursing practice based on holistic attitudes is integrated with philosophical thinking. Critical thinking helps nurses analyze experiences and situations and better evaluate the challenges of beliefs, values and hypotheses, and promotes their ability to rationalize, predict complications and transfer knowledge in clinical situations, thereby improving their competency in clinical situations. Philosophical thinking and teaching this type of thinking currently appear the missing link in nursing education, nurses’ insights and attitudes and nursing care. To promote the services planned in the existing nursing curricula, creative and critical thinking and caring-based humanitarian thinking are recommended to be integrated with nursing education and in-service training as the most important parts of the nursing process.
4.1. Study Limitations
The present study limitations comprised a lack of access to the full text of some articles, on which the researcher had no control, as well as the limited number of Studies available on the role of philosophy in nursing.
